Provider Demographics
NPI:1427048438
Name:WURST, SANDY SCHMIDT (O D)
Entity type:Individual
Prefix:DR
First Name:SANDY
Middle Name:SCHMIDT
Last Name:WURST
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:K
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14701 E EXPOSITION AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2623
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2283152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO026190OtherKAISER COMMERCIAL NUMBER
CO54607728Medicaid
CO026190OtherKAISER COMMERCIAL NUMBER
CO400373YK5YMedicare PIN